{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T15:26:26Z","timestamp":1789658786799,"version":"4.0.1"},"reference-count":35,"publisher":"Georg Thieme Verlag KG","funder":[{"name":"Founding of First Affiliated Hospital of Zhejiang University, School of Medicine","award":["BQD"],"award-info":[{"award-number":["BQD"]}]},{"name":"National Natural Science Foundation of China","award":["81970995"],"award-info":[{"award-number":["81970995"]}],"id":[{"id":"https:\/\/ror.org\/01h0zpd94","id-type":"ROR","asserted-by":"crossref"}]},{"name":"National Natural Science Foundation of China","award":["82571349"],"award-info":[{"award-number":["82571349"]}],"id":[{"id":"https:\/\/ror.org\/01h0zpd94","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endoscopy"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Hypoxia from sedation-induced upper airway obstruction remains a major risk during endoscopy in patients with obesity. Nasal cannulae provide oxygenation but do not address obstruction. The Capnography Monitoring Bite Block Oxygenation endoscopy oropharyngeal airway device (COMBO) was feasible in a pilot study, but its efficacy compared with standard care remains unclear. This multicenter randomized controlled trial (RCT) evaluated whether the COMBO device reduces hypoxia vs. standard nasal cannula (SNC) in patients with obesity undergoing sedated endoscopy.<\/jats:p>\n                  <jats:p>In this multicenter RCT at three Chinese hospitals, adults with a body mass index \u226528 kg\/m\u00b2 undergoing sedated endoscopy were randomized 1:1 to the COMBO device or SNC. All patients received oxygen (6 L\/min) and end-tidal carbon dioxide monitoring. The primary outcome was hypoxia (blood oxygen saturation \u226575% to &lt;90% for &lt;60 seconds).<\/jats:p>\n                  <jats:p>591 patients were analyzed. The incidence of hypoxia was lower in the COMBO group than in the SNC group (6.4% [19\/298] vs. 21.5% [63\/293]; absolute difference, \u221215.1%, 95%CI \u221220.6 to \u22129.7; P &lt; 0.001), and the incidence of subclinical respiratory depression was also lower in the COMBO group (15.1% [45\/298] vs. 27.6% [81\/293]; absolute difference \u221212.5%, 95%CI \u221219.1 to \u22126.0; P &lt; 0.001). Severe hypoxia did not differ significantly (0% vs. 0.3% [1\/293]; P &gt; 0.99). Other sedation-related adverse events were comparable.<\/jats:p>\n                  <jats:p>The COMBO device was associated with significantly less hypoxia during sedated endoscopy in patients with obesity, without increasing adverse events. By maintaining airway patency and enabling monitoring, it may provide a safe and effective strategy for high-risk patients.<\/jats:p>","DOI":"10.1055\/a-2939-4274","type":"journal-article","created":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T22:30:20Z","timestamp":1786919420000},"source":"Crossref","is-referenced-by-count":0,"title":["Oropharyngeal airway integrated with capnography and oxygenation for sedated gastrointestinal endoscopy in patients with obesity: a randomized trial"],"prefix":"10.1055","clinical-trial-number":[{"clinical-trial-number":"nct06796764","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Mingxia","family":"Xu","sequence":"first","affiliation":[{"name":"The First Affiliated Hospital of Zhejiang University School of Medicine, China","place":["Hangzhou"],"department":["Department of Anesthesiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saiheng","family":"Xiang","sequence":"first","affiliation":[{"name":"The First Affiliated Hospital of Zhejiang University School of Medicine, China","place":["Hangzhou"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianhong","family":"Xu","sequence":"additional","affiliation":[{"name":"The Fourth Affiliated Hospital of Zhejiang University School of Medicine, China","place":["Yiwu"],"department":["Department of Anesthesiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pingbo","family":"Xu","sequence":"additional","affiliation":[{"name":"Zhejiang Cancer Hospital, China","place":["Hangzhou"],"department":["Department of Anesthesiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhuan","family":"Zhu","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Zhejiang University School of Medicine, China","place":["Hangzhou"],"department":["Department of Anesthesiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengfei","family":"Huang","sequence":"additional","affiliation":[{"name":"The Fourth Affiliated Hospital of Zhejiang University School of Medicine, China","place":["Yiwu"],"department":["Department of Anesthesiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zihan","family":"Mu","sequence":"additional","affiliation":[{"name":"Zhejiang Cancer Hospital, China","place":["Hangzhou"],"department":["Department of Anesthesiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Sun","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Zhejiang University School of Medicine, China","place":["Hangzhou"],"department":["Department of Anesthesiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunxin","family":"Shi","sequence":"additional","affiliation":[{"name":"Fudan University, China","place":["Shanghai"],"department":["Department of Biostatistics, Key Laboratory of Public Health Safety of Ministry of Education, NHC Key Laboratory for Health Technology Assessment, School of Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongxing","family":"Yao","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Zhejiang University School of Medicine, China","place":["Hangzhou"],"department":["Department of Anesthesiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9755-1025","authenticated-orcid":false,"given":"Diansan","family":"Su","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Zhejiang University School of Medicine, China","place":["Hangzhou"],"department":["Department of 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